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Types of treatment for pancreatic cancer

The type of treatment you have depends on your type of pancreatic cancer, how far it has spread (the stage), and your general health and level of fitness.

Surgery to remove cancer

If it is possible to remove your cancer and you are fit enough to cope with major surgery, then your surgeon will offer you an operation.

Surgery or stents to relieve symptoms

Even if your cancer cannot be removed, you may have surgery to relieve symptoms of a blocked bile duct or duodenum. This is called bypass surgery. These days, however, you are more likely to have a small tube (stent) put in to relieve a blockage. A stent in the bile duct can help with jaundice, as it allows bile to flow into the bowel again. Keeping the duodenum open with a stent helps keep the digestive system working.

Chemotherapy and radiotherapy

Chemotherapy after surgery for an early stage cancer can help lower the risk of the cancer coming back. If you have advanced pancreatic cancer you will have chemotherapy to shrink the cancer and relieve symptoms. It will also help some people to live longer. You need to be well enough to cope with the side effects of this treatment.

Radiotherapy is used less often than surgery and chemotherapy to treat pancreatic cancer. Your specialist may suggest radiotherapy to shrink your tumour, to help relieve symptoms such as pain. Sometimes doctors may try a combination of radiotherapy and chemotherapy to treat cancers that cannot be removed with surgery.

Surgery to remove pancreatic cancer

When you are diagnosed with pancreatic cancer, your specialist will do tests to see if it is likely to be possible to remove your cancer. If it is, your surgeon will offer you an operation. This is most likely for stage 1 and some stage 2 pancreatic cancers. Surgery to remove cancer of the pancreas involves long and complicated operations. So you must also be fit enough to undergo the operation. There is more about this and what the operations involve in the section on surgery to try to cure pancreatic cancer.

If your cancer has spread to another area of the body, then an operation to try to remove it will not cure you. You would undergo very major surgery and still have cancer. Unless your surgeon can remove all the cancer, there is no point in going through this. If you have a pancreatic neuroendocrine tumour that has only spread to the liver, it may still be possible to have surgery.

If it is possible to remove the cancer, there is no guarantee that it won't come back. Cancer cells may have broken away before your operation. These would be too small to see on scans. But they can grow into another tumour later. Your specialist may suggest chemotherapy after your surgery to try to stop the cancer from coming back.

Surgery to relieve symptoms

In most people, pancreatic cancer is diagnosed too late for an operation to remove it. But in some cases you may need an operation to get round a blockage in your bile duct or duodenum. This is called bypass surgery. This helps to relieve symptoms such as jaundice or sickness. There is more about this in the section on surgery to relieve symptoms of pancreatic cancer.

However, these days you are more likely to have a tube (stent) put in to your bile duct or duodenum to relieve symptoms, rather than surgery.

Using stents to relieve symptoms

A stent is a medical word for a small tube. Doctors use stents to relieve blockages.

Jaundice is caused by cancer blocking your bile duct. Many people with pancreatic cancer have jaundice. This is particularly likely if you have a cancer of the head of the pancreas. If cancer blocks the very top of your small bowel (duodenum), you can feel very sick and may vomit. This is because food and drink cannot pass from your stomach into the bowel in the normal way.

Your doctor puts a stent into the blocked bile duct or duodenum to keep it open. This isn't an operation as such. It is most often done during an endoscopy. Or for a blocked bile duct, the stent can be placed through the skin with local anaesthetic. The doctor guides the stent into position using X-ray. The doctors that put stents in are usually specialists in performing procedures with X-ray (radiologists) or endoscopy (endoscopists) rather than surgeons.

Chemotherapy for cancer of the pancreas

After surgery to remove pancreatic cancer, you usually have chemotherapy to help lower the risk of the cancer coming back. You are likely to have about 6 months of gemcitabine or fluorouracil (5 FU) chemotherapy.

For advanced pancreatic cancer, your doctor may offer you chemotherapy to shrink the cancer and relieve symptoms. Chemotherapy may also help some people to live longer. You are likely to have a combination of chemotherapy drugs.

Radiotherapy for cancer of the pancreas

Doctors don't use radiotherapy as much as surgery or chemotherapy for pancreatic cancer. But they may offer it in some circumstances. Your specialist may suggest radiotherapy to try to shrink your tumour and to relieve symptoms.

Sometimes doctors try a combination of radiotherapy and chemotherapy to treat locally advanced cancers that cannot be removed with surgery. In trials, doctors are also looking at radiotherapy and chemotherapy before surgery for early pancreatic cancer.

Choosing the right treatment for you

The type of treatment you have for cancer of the pancreas depends on

The stage of the cancer

The type of pancreatic cancer you have

Your general health and level of fitness

The stage of your cancer means how advanced it is or how widely it has spread. Many of these cancers are not diagnosed until the cancer is quite advanced and so may not be curable. As with many types of cancer, the earlier the cancer is diagnosed, the easier it is to get it under control and possibly cure it.

Your general health and fitness matter because an operation to remove pancreatic cancer is major surgery. You need to be fit enough to get through it. Age is one factor in fitness, but obviously people vary a lot. Your doctor will not make a decision based only on your age.

You will be looked after by a multidisciplinary team. The team is made up of various health professionals who work together to plan how best to manage your treatment and care. The team includes specialist surgeons, doctors who specialise in chemotherapy and radiotherapy (oncologists), specialist nurses, psychologists, dieticians and other health professionals. They will discuss with you the possible treatments you could have and how they may affect you.

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